Introduction. The second wave of COVID-19 has spread across India causing unprecedented misery to people since March 2021. Kidney transplant recipients (KTRs) are at an increased risk of severe infection. Their outcomes appear to be worse than those in the general population. There is no robust evidence or consensus to support any form of treatment protocol or modification of immunosuppression in KTRs with COVID-19. There is a need to develop effective and safe therapeutic protocols for this frail population. Remdesivir is the only approved antiviral drug in COVID-19 till now. Methods. We describe clinical features, role of HRCT, therapeutic protocols, and mortality rate of 20 KTRs with SARS-CoV-2 infection. Results. Complete recovery was seen in 8 (40%) patients monitored at home. 12 (60%) patients with HRCT scores more than 8/25 were hospitalized. 11 (55%) had hypoxia, of these 8 (40%) had mild hypoxia, 1 (5%) required NIV, and 2 (10%) needed mechanical ventilation. Immunosuppression was modified in all the patients. Remdesivir and dexamethasone were administered to the hospitalized patients. 1 (5%) patient had AKI requiring RRT. 1 (5%) patient expired, and 1 still hospitalized. 10 of the hospitalized patients recovered. Out of the total 20 patients, 18 (90%) recovered completely within two weeks of infection. Conclusion. Clinical presentation of COVID-19 in KTRs was similar to nontransplant patients. Early hospitalisation and assessing the severity by HRCT were important. Continuing tacrolimus and administering remdesivir and dexamethasone reduced the incidence of renal failure and improved survival rates.

COVID-19 pandemic affected millions of people across India. COVID-19 cases are fewer in children with less severity and better outcomes than in adults. However, a small proportion develop severe illness and succumb to the disease. Clinical manifestations and optimal management of COVID-19 in immunocompromised children are not clearly known. Remdesivir was shown to be efficient in reducing the recovery time in COVID-19 patients requiring supplemental oxygen. Remdesivir is approved for use in children with severe COVID-19, but there are no guidelines in patients with risk factors like recent solid organ transplantation. We report a case of a 10-year-old kidney transplant recipient (KTR) infected with severe acute respiratory syndrome corona virus-2, 2.5 months after the transplantation. Unlike most children, he presented with high fever, cough, and vomiting. His inflammatory markers were elevated. In this case report, we discussed management and clinical outcomes of this patient. In view of recent kidney transplantation and the severity of infection with emergent oxygen requirement, we gave him remdesivir. We continued prednisolone and tacrolimus and stopped mycophenolate. He recovered completely in 7 days. We feel that severely immunosuppressed KTR children with COVID-19 will benefit with remdesivir administration. Monitoring tacrolimus trough levels is essential for maintaining adequate immunosuppression.